ch 31 the child with endocrine dysfunction Flashcards
type of hormone: create the effect near the point of secretion
local hormone
type of hormone: released into the bloodstream
where they are carried to responsive tissues
general hormone
what 2 regulatory systems maintain homeostasis
endocrine system
autonomic nervous system (sympathetic and parasympathetic)
when does hormonal control of bodily functions regulate for children
12-18 months old
what hormone is deficient in hypopituitarism
growth hormone
how is diagnosis of hypopituitarism made
-plasma growth hormone levels
-hand xrays
Tx hypopituitarism
-biosynthetic growth hormone injections
-thyroid extract
-cortisone
-testosterone/estrogen/progesterone
what is the best time of day to give biosynthetic growth hormone injection
before bed
Rare neurodegenerative
condition reported in some
patients after receiving
human GH from cadavers
Creutzfeldt-Jakob Disease (CJD)
“human mad cow disease”
what disorders can hyperpituitarism result in
-acromegaly
-cushings disease
-galactorrhea
S+S acromegaly
-excess growth hormone, overgrowth of long bones
-increased muscle
-typical facial features
how is diagnosis of acromegaly made
-radiologic studies
-endocrine studies
Tx hyperpituitarism
-surgery to remove tumor
-radiation/radioactive implants
-hormone replacement therapy
what ages do precocious puberty occur in girls? boys?
girls: before 8 yo
boys: before 9 yo
3 types precocious puberty
-central
-peripheral
-incomplete
potential causes of precocious puberty
-disorder of gonads
-disorder of adrenal glands
-disorder of hypothalmic-pituitary-gonadal axis
med for Tx precocious puberty
when is it discontinued
lupron: slows prepubertal rates
stop med at normal puberty age
primary causes of diabetes insipidus (DI) ? secondary causes?
primary: hyposecretion of ADH
secondary: trauma, tumor, CNS infection, aneurysm
S+S diabetes insipidus in children? infants?
children:
-polyuria
-polydipsia (thirst)
-first sign often enuresis (bedwetting)
-dehydration
-high H&H
-high serum osmolarity
infants:
-irritability relieved by water (not milk)
meds for Tx of DI
-daily hormone replacement of vasopressin
-DDAVP (oral/nasal/IM/SQ)
*treatment for life
nursing interventions for DI
-accurate I&Os
-observe for signs of fluid overload
-seizure precautions
-DDAVP 2x/day
Produced by
hypersecretion of the
posterior pituitary
(increased ADH)
syndrome of inappropriate antidiuretic hormone (SIADH)
S+S SIADH
-fluid retention (water intoxication, overhydrated)
-anorexia
-N/V
-weight gain
-hyponatremia
-low serum osmolarity
-irritability
-personality changes
risk with DI
hypovolemic shock
risk with SIADH
seizures
common S+S between DI and SIADH
excessive thirst
Tx SIADH
hypertonic saline
fluid restriction
causes juvenile hypothyroidism
-congenital
-acquired (after thyroidectomy or radiation)
S+S hypothyroidism
-slowed growth
-excessive weight gain
-constipation
-sleepiness
-delayed puberty
-dry skin, sparse hair, periorbital edema
Tx hypothyroidism
-thyroid hormone replacement
-prompt Tx needed for brain growth in infant
causes hyperthyroidism
-congenital (usually from maternal use antithyroid drugs during pregnancy)
-acquired (neoplasm, inflammatory disease, dietary deficiency, increased secretion thyrotropic hormone)
important consideration for infant born with hyperthyroidism (goiter)
-precautions for emergency ventilation
-hyperextension of neck helps with breathing
most common cause thyroid disease in children/teens
lymphocytic thyroiditis
S+S lymphocytic thyroiditis
-lymphocytic infiltration of thyroid gland
-inflammation
-hyperplasia (goiter)
-usually euthyroid but with S+S of hypothyroidism
Tx lymphocytic thyroiditis
-may resolve spontaneously within 1-2 yrs
-oral thyroid hormone helps decrease goiter
-surgery is contraindicated
S+S hyperthyroidism (graves disease)
-exopthalmos
-excessive motor irritability, tremors, insomnia, short attentions pan
-GI hyperactivity (diarrhea)
-rapid bounding pulse
-dyspnea (even with light exertion)
-heat intolerance (skin is warm and flushed)
Dx of graves disease
-increased T3 and T4
-decreased TSH
Tx graves disease
-antithyroid drugs (PTU and methimazole)
-subtotal thyroidectomy
-ablation with radioiodine
what things can cause thryotoxicosis “thyroid storm”
-infection
-surgery
-discontinuation of antithyroid therapy
Tx thyrotoxicosis
-antithyroid drugs
-propranolol
what can you not eat when you take thyroid replacement meds
no dairy within 1-2 hrs of taking med
how does parathyroid hormone maintain serum calcium
-bone breakdown to release calcium and phosphate
-helps kidneys absorb calcium and excrete phosphate
-promote calcium absorption in GI tract
2 types hypoparathyroidism
-autoimmune hypoparathyroidism
-pseudohypoparathyroidism
type of hypoparathyroidism: deficient production of parathyroid hormone
autoimmune hypoparathyroidism
type of hypoparathyroidism: production of parathyroid hormone is increased but organs are unresponsive to it
pseudohypoparathyroidism
facial muscle spasm elicited by tapping facial nerve in region of parotid gland
chvostek sign
carpal spasm elicited by pressure applied to upper arm
trousseau sign
carpopedal spasm (sharp flexion wrist and ankle joints), muscle twitching, cramps, seizures, stridor
tetany
earliest indication hypoparathyroidism
*anxiety and mental depression
then paresthesia and heightened neuromuscular irritability
S+S hypoparathyroidism
-dry scaly skin with eruptions
-brittle hair and nails
-tetany
-paresthesia
-tingling
-laryngeal stridor
-headache
-seizures
-depression, confusion, memory loss
-positive chvostek and trousseau signs
primary and secondary causes of hyperparathyroidism
primary: adenoma of gland (catecholamine secreting tumor)
secondary: chronic renal disease, congenital abnormalities of urinary tract
Tx hyperparathyroidism
-surgical removal
-or treat underlying cause
-address hypercalcemia
three groups of secretions from adrenal cortex
-glucocorticoids (cortisol)
-mineralcorticoids (aldosterone)
-sex steroids (androgens, estrogens, progestins)
what does the adrenal medulla secrete
catecholamines: epinephrine and norepinephrine
causes acute adrenocortical insufficiency “adrenal crisis”
-hemorrhage into gland after trauma
-sudden severe infections
-abrupt withdrawal supplemental cortisone
-failure to increase cortisone during times of stress
what is chronic adrenocortical insufficiency called (not enough cortisol)
addisons disease
possible causes cushings syndrome (too much cortison)
-excessive/prolonged steroid therapy
-excess ACTH production from pituitary
-hypersecretion glucocorticoids from adrenal
-extrapituitary neoplasm
-inappropriate adrenal response to secretion of polypeptide (food dependent)
S+S cushings disease
-excessive hair growth
-moon face
-weight gain
-truncal obesity with red striae
-poor wound healing
-ecchymosis
how is Dx of cushings disease made
-blood test: excess cortisol levels
-xray
-fasting blood glucose
-serum electrolytes
-24 hour urine
Tx cushings disease
-surgery
-replacement of growth hormone, ADH, thyroid hormone, gonadotropins, steroids
A family of disorders caused by
decreased enzyme activity
required for cortisol production
in the adrenal cortex; overproduction of adrenal androgens
congenital adrenal hyperplasia (CAH)
S+S congenital adrenal hyperplasia (CAH)
-male: precocious puberty
-female: born with varying degrees of ambiguous genitalia (enlarged clitoris, fused labia, intact internal sex organs)
what juices should be given with calcium replacement med to help it be absorbed better
cranberry juice
apple juice
Dx CAH
-ultrasound of pelvic organs
-chromosome typing
-newborn screening measurement of cortisol precursor
Tx CAH
-assign sex according to gene phenotype
-cortisone to suppress oversecretion ACTH
-reconstructive surgery prn
-teach parents to watch for dehydration and salt-losing crises
S+S hyperaldosteronism
-HTN
-hypokalemia
-polyuria
Tx hyperaldosteronism
-replacement potassium
-spironolactone
Adrenal tumor that secretes catecholamines
pheochromocytoma
Tx pheochromocytoma
-*do not palpate (releases more catecholamines)
-surgical removal of tumor
-maybe bilateral adrenalectomy, lifelong glucocorticoid and mineralcorticoid replacement
3 types diabetes mellitus (DM)
-type 1 DM
-type 2 DM
-maturity-onset diabetes of the young (MODY)
type of diabetes: Characterized by destruction of beta cells, usually leading to absolute insulin deficiency
T1 DM
what children are at increased risk for T2DM
-native american
-hispanic
-african american
cause T2DM
insulin resistance
type of diabetes: Transmitted as autosomal dominant disorder with formation of structurally abnormal insulin with decreased biologic activity
maturity-onset diabetes of the young (MODY)
who is more likely to develop MODY
-obese teens
-<25 yo
Tx MODY
-oral hypoglycemic meds
-diet modification
Tx T2DM
-insulin injections
-diet modification
Hyperventilation characteristic of metabolic
acidosis resulting from the respiratory
system’s attempt to eliminate excess CO2 by
increased depth and rate; seen in ketoacidosis
kussmaul respirations
what can cause diabetic ketoacidosis (DKA)
-dehydration
-electrolyte imbalance
-acidosis
-coma
S+S ketoacidosis
-ketones in urine
-ketones in breath (fruity smell)
-kussmaul respirations (hyperventilation)
when would you do urine testing for ketones for T1DM
-q3h during illness
-glucose >240 if not sick
management T1DM
-insulin therapy
-glucose between 80-120
-measurement A1C
longterm complications DM
-microvascular: nephropathy, retinopathy
-macrovascular: neuropathy
nursing consideration when running insulin through IV
*run 50-100 mL out for priming
it takes 50-100 mL for tubing to be saturated and not have insulin stick to it
what fluids are given for DKA
normal saline
(no dextrose)
bolus = 20 mL/kg in <20 mins
IV drip: 0.1 U/kg/hr normal insulin
peak + duration regular insulin (rapid acting)
30-90 mins
(duration 5 hrs)
peak + duration short acting insulin
peak 2-4 hrs
duration 4-8 hrs
peak + duration intermediate acting insulin
peak 4-14 hr
duration 20 hrs
peak + duration long acting insulin (lantus)
no peak
lasts 24 hrs
how do you draw up multiple types of insulin in one syringe
clear to cloudy
